Applicant: __________________________________ Date: _____________ Telephone_________

Street Address of Proposed Use: __________________________________________________

1. Please provide the following drawings:
     a) Floor plan      b) Site plan showing the on-site parking

2. Proposed Use of Building(s) at Subject Address:
________________________________________________________________________

3. Proposed Number of Employees on Property:

a) At any one time __________________ b) Total ____________________________

4. Proposed Days of Operation:________________________________________________

5. Proposed Hours of Operation:_______________________________________________

6. Proposed Maximum Number of Customers Expected on the Property Daily?
________________________________________________________________________

7. Proposed Maximum Number of Vehicular Trips Associated with the Use Daily:
________________________________________________________________________

8. Proposed Types of Machines, Equipment, Materials, etc.:
________________________________________________________________________

9. Number of On-Site Parking Spaces (do not includes street parking):
________________________________________________________________________

10. Square Footage of Building: ________________________________________________

11. Square Footage of Area of Building Intended for Subject Use:
________________________________________________________________________

12. Previous Use of Building at Subject Address:
________________________________________________________________________